Cholesterol-Lowering Drugs May Prevent Fracture Risk

But randomized trials are needed to settle this controversial issue, researchers add

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By Steven Reinberg
HealthDay Reporter

MONDAY, Sept. 26, 2005 (HealthDay News) -- People taking cholesterol-lowering drugs known as statins may also be protecting themselves from fractured and broken bones, results of a large, new study suggest.

Just how statins prevent fractures is not clear. Several reasons have been suggested, including reduced inflammation and improvement in the function of small blood vessels, thus aiding growth of new bone, the researchers said.

In addition, whether the effect is real has been a matter of debate. Some earlier studies have shown an association between statins and reductions in fractures, and some have shown no effect at all.

The new report, which appears in the Sept. 26 issue of the Archives of Internal Medicine, includes data on more than 90,000 mostly older male patients. This is the first study looking at the benefit of statins that includes a large number of men, the researchers noted.

"These drugs are known for their cardiovascular risk reduction," said lead author Dr. Richard E. Scranton, a clinician investigator from the Massachusetts Veterans Epidemiology Research and Information Center.

"They reduce the risk of having heart attacks and strokes, but there is really no good evidence that they would reduce the risk for fractures," he said. "But this study indicates that you could have one drug that could potentially reduce the risk of heart attacks and fractures."

Among elderly men in the study, those taking statins experienced a 36 percent reduction in the risk for broken bones, Scranton said.

In their study, Scranton's team collected data on 91,052 patients enrolled in the Veterans Administration health-care system. Of these patients, 28,063 were taking statins and 2,195 were taking other cholesterol-lowering drugs.

The researchers found that those taking statins were at a 36 percent lower risk of fractures compared with those not taking any cholesterol-lowering drugs, and a 32 percent lower risk of fractures compared with patients taking cholesterol-lowering drugs other than statins.

Scranton said that, based on this observational study, it is still not clear whether older people should take statins in hope of reducing fractures. "But the question is too important to ignore," he said. "What needs to be done is a randomized control trial to take patients who are at risk for fractures and see if the use of statins would prevent that."

One expert thinks that the evidence is not anywhere near conclusive on whether statins reduce fracture risk.

"Previous data have also suggested that statins may reduce the incidence of vertebral fractures," said Dr. Stephen Honig, the director of the Osteoporosis Center at the Hospital for Joint Diseases in New York City.

Smaller trials designed to look at fracture incidence have not provided evidence that support some of the larger retrospective studies, Honig added. "There is recent data suggesting that statins may improve bone density scores, but confirmation for this finding is also needed."

Statins have been shown to stimulate bone proteins and may stimulate bone-forming activity, so they may have biologic effects on bone beyond their presumed effect on cholesterol, Honig said. "The rationale is thus in place for these drugs to have a place in fracture prevention."

"There are many problems with large retrospective observational studies, and to date, the smaller randomized prospective studies addressing the question of fracture prevention and bone density gains have produced conflicting results," Honig said. "As many others have stated, there is a need for a prospective randomized control trial looking at these drugs as treatments for osteoporosis."

More information

The American Heart Association can tell you more about statins.

SOURCES: Richard E. Scranton, M.D., M.P.H., clinician investigator, Massachusetts Veterans Epidemiology Research and Information Center, Boston; Stephen Honig, M.D., director, Osteoporosis Center, Hospital for Joint Diseases, New York City, Sept. 26, 2005, Archives of Internal Medicine

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